Provider Demographics
NPI:1275829509
Name:PAUL PONCZA DDS PC
Entity Type:Organization
Organization Name:PAUL PONCZA DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:PONCZA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-525-5545
Mailing Address - Street 1:1350 W BELMONT AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3245
Mailing Address - Country:US
Mailing Address - Phone:773-525-5545
Mailing Address - Fax:773-337-4988
Practice Address - Street 1:1350 W BELMONT AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3245
Practice Address - Country:US
Practice Address - Phone:773-525-5545
Practice Address - Fax:773-337-4988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-24
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019026404332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies